B-2017-1423 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-1423
10980 MARIA ROSA WAY CUPERTINO,CA 95014-4720(356 18 004) M C ROOFING
SAN JOSE,CA 95127
OWNER'S NAME: BECCIA DORIS C TRUSTEE DATE ISSUED:08/24/2017
OWNER'S PHONE:408-253-0428 PHONE NO:(408)729-3436
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class C-36 Lic.#736883
Contractor M C ROOFING Date 06/30/2019 X BLDG _ELECT _PLUMB
MECH X RESIDENTIAL_COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing —
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
RE-ROOF;TEAR OFF;INSTALL SHIELD TECH; COMP SHINGLES-
I hereby affirm under penalty of perjury one of the following two declarations: (37 SQ)
i. I have and will maintain,a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
Ii`rfonnance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$19000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 356 18 004
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations per the Cupertino Municipal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
S' ure Date 8/24/2017 Issued by:Jasmine Archbold
Date:08/24/2017 •
OWNER-BUILDER DECLARATION
'
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following;two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
1. I,as'owner of the propertyor my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code) -Y`
4 X:
2. I,as owner of the property,am exclusively contracting with licensed S.wfrt'"� e of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). g7i'ate:8/24/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
permit is issued.
s. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the H th&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owne, authorized agent:
APPLICANT CERTIFICATION D /24/2017 ,
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply;with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Signature Date 8/24/2017 Licensed
Si
g Professional
CONSTRUCTION PERMIT APPLICATION
w*vr.14`� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO,CA 95014-3255
45-crass --77
(408) 777-3228 • building@cupertino.org PEMIT#B- 20I - - I L(Z?j
CUPERTINO REV# DEF#
❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.I. ❑MEp KRE-ROOF ❑SWIMMING POOL/SPA
PROJECT ADDRESS',p }go �eN"R\ A A\/• APN# 3 sic, - I 8 -
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OWNE NAME i / , l PHONE ^� E-MAIL
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STR ET!DDRESS CITY, ATE,ZIP _
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ONTRACTOR NAME 0 OWNER-BUILDE COMPANY NAME LICENSE NUMBER LICENSE TYPE
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CONTACT NAME E-MAIL
STREET ADDRESS V CITY,STATE,ZIP PHONE
DECRIPTON `
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❑SINGLE-FAMILY/DUPLEX ❑'MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL I
,EXISTING USE EXISTING SF NEW FLOOR SF PORCH SF DECK SF DEMO SF STORIES# TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION($)
•
IREMODEL REMODEL KITCHEN REMODEL OTHR GARAGE ❑ATTACHED
. I BATHROOM SF 'SF SF SF. 0 DETACHED
IEXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION 0El YES
(FIRE SPRINKLERS D NO , 0 NONO
!DWELLING SECOND DWELLING 0 YES 0 ATTACHED❑DETACHED OTHER
,UNITS# UNIT ADDITON:� 1 ❑No '' S F
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POOLS! ❑FIBERGLASS!'❑;VINYL,-LINED ElGUNITE 0 PREFABRICATED
!POOL-SF SPA-SF! !SPA:ATTACHED ❑YES ._0 NO TOTAL-SF
I 1 RECEIVED BY: TAL VALUATIO
Commercial or Multi-Family Buildings with Public Swimming Pools requires Department of Environmental Heath approval
! ��O�1 1 C /
RE-ROOFI EXISTING ROOF TYPE: ®BUILT-UP ROOF EKPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPEC )
REMOVE/REPLACE❑NO IF NO! i PLYWOOD ❑Imo -, ❑3/8" / PLYWOOD TYPE: 5/jI W PITCH: ROOF CLASS
S #OF LAYERS: ATHICKNESS El5/8" OTHER 7�/!1 El OSB El CDX OTHER/1�'C1L :12 A
PROPOSED ROOF TYPE:❑BUILT-UP ROOF i❑ASPHALT SHINGLES 0 WOOD SHAKES❑WOOD SHINGLES 0 OTHER
�
'
*Provide a signed copy Of the Ciipertino's Tear-Off Policy SF_'>�A'o #of SQuAREs�
,By my signature below I certify to'each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I -
have read this application;and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree
to comply with all applicable locali ordinances and state laws relating to building construction. I authorize representatives of Cupertino to
enter the above-identified Ipropertyi for inspection nrp4' 4
kno e and authorize all information cont ' ed on this application form '
to be made available for public'record•
Signature of Applicant%Agent: I // /may4 {G ✓ Date: re2:7) 6 7 .
SUPPLEMENTAL INFORMATION REQUIRE
*New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction.
*Commercial Buildings: Provide a1 completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. ,
*Copy of Planning Approval Letter or-Meeting with Planning prior to submittal of Building Permit application.
*HOA-Provide a letter of approvaliIfroin the Home Owner's Association
•
1 BldgApp_2017.doc revised 08/01/17
1
ply7H REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT 4BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O.,BUILDING OFFICIAL
C 6Pt k 0 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408) 777-3228• FAX(408)777-3333 buildingpeunertina.orn I —2-0 1 —
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'I UNDERSTAND AND AGREE T .THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2016 California Codes.
2. An inspection request can be scheduled u to one business da before.the.re nested ins ection date.
To schedule inspections call (408) 777-3228 from 7:3473 3Opm(MOn4hurs)Or 7:30-2:36pm(Friday)to
schedule inspection.: For Tear-Oil and Nailing InspectionS,You must also call on.the day of the
inspection only after,that phase of the work is completed: The building inspector will be out to the
job site within,one hour. The hour S for this service are: 7:304.0;30am and 12:30-3:30 (Mon-Thurs),
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3: Tear-Off inspection:is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knoeica-down or removed prior to this inspection.
4. If plywood is instat141, a plywood Nailing jiLspsslion is required.
S. Roofing shall not'beapplied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing Which is applied without first obtaining an approved inspection will
require the removal'of all new material down to the sheathingso a proper inspection can be performed.
6. A Final inspection and approval shall be obtainedfromthe building inspector when the re-roofing is
completed. To receive a final Sign;off,the following iterns:will be verified:
a. Flat roofs.Shall have a minimum of 1/4" per foot ofSlope and:demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre7manufactured products used shall be
available on-site to revieW at the time of the inspection.
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed,
7. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection.fee. The re-inspection fee shall be.:paidbefore another inspection can be
scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. Iunderstand and agree to comply with the re-roof policy stated above. I also understand that
=eke detectors and carbon monoxide detectors.are required to be installed in accordance with Sections R314 and 1p 15 of
the 2016 California Residential cod-. . ,
Signature of:ApplicanAgett& Date:
Reroeolicy 2014.doc revised 06/01.7
SMOKE / CARBON MONOXIDE ALARMS
• OWNER CERTIFICATE OF COMPLIANCE
='g COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CtiPEFii INf� 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333• building(a cupertino.orq
PERMIT=CAN1TO.T I NALED: NTT TOW CE130FICA`TE;145 BEEN
CoLITED,SIGNED AND TURNED TO ' E BI. IN G DIVISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms
for compliance with 2016 CRC Section R314,2016 CBC Sections 420 6 and 907.2 11.2 where no interior access
for inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000 00,CRC Section R314 and CBC Sections 907.2.11.5 and 420 6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X X
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal.
Power Supply.In dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.114 and 420 6.2. An electrical permit is required for
alarms which must be connected to the building wiring
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance With the manufacturer's instructions and in compliance with the California Building
and California Residential Codes The alarms specified below have been tested and are operational, as of the
date signed below
Address +j`L 2 (/` / Permit No._ f —�!
Specify Number of Alarms: #Smoke Alarms. I 5 J #Carbon Monoxide Detectors 2..
I have read and agree to comply with the terms and conditions of this statement
Owner( 9
r Owner A ent's i Name:
�
/ ��5 �� Gl Signature Date:
Contractor Name: ,ya
ure • ic.# ��•� +-? Date:
Signat
, \44s%\3U e._LCA-s\-
Smoke and CO fonn.doc revised 12/15/16